National Organ Donation Day
Before 1994, the only way to get a heart transplant for Indians suffering from end-stage heart failure was to go abroad –a luxury that most could not afford.
After the Transplantation of Human Organs Act was passed on July 8, 1994, a group of surgeons led by Dr. P. Venugopal successfully performed India’s first heart transplant at the All-India Institute of Medical Sciences (AIIMS) on 3rd August, of the same year.
It was a landmark legislation that recognised brain death as a type of death and laid the regulatory framework for the removal, storage and transplant of human organs for therapeutic purposes.
Dr Venugopal, Chief of Cardiothoracic and Vascular Surgery at AIIMS and his team had been perfecting transplant surgery techniques on animals. Devi Ram, a 40-year-old heavy industry worker suffering from cardiomyopathy and had been admitted to AIIMS for three months. He belonged to the AB+ blood group, a universal recipient blood group. A 35-year-old lady who had suffered a brain haemorrhage was brought into the hospital and declared brain dead. Her family agreed to donate her heart. All the conditions were suitable and compatible, and the team was ready.
On August 3, 1994, in a 59-minute procedure, a team of 20 surgeons led by Dr. Venugopal conducted India’s First successful heart transplant surgery. Devi Ram lived on for 15 more years until he died of an unrelated issue.
The problem
Kidney failure is likened to a ‘silent tsunami’ – the symptoms may not show up till the end–stage and by the time it gets detected, it deals a big blow to the patient and his/her family. Incidents of alcoholic and Non-alcoholic liver failure are on the rise.
Estimatedly, more than a million Indians suffer from end-stage organ failure annually and are waiting to receive a life-saving organ. However, at least 10 patients die every day while waiting. Every ten minutes, a new name is added to the waiting list. More than 2,50,000 patients undergo dialysis every year. In Goa alone, there are many undergoing dialysis and around 60 on the waiting list for a kidney transplant. This waiting list is maintained by a body called SOTTO (State Organ and Tissue Transplant Organisation), located at GMC Goa. The deceased organ donation program is called ‘Nave Jivit’.
Solution – Organ donation
An organ transplant is the only way of reversing end-stage organ failure. The transplant enables them to lead normal lives. However, a transplant would need the donation of a healthy organ by a living or a deceased (dead) person (Donor).
Organ donation is legal. The Transplantation of Human Organs Act (THOA) allows for organs of a Brain-dead person to be donated provided their family members consent to it. In India presently, more than 90% of the transplants take place thanks to a living donor – invariably a close family member.
We need to work on increasing the rate of deceased organ donation so that over time, we stop relying on the goodness of an otherwise healthy person to donate their organs or a part thereof.
Circulatory death/Cardiac death
This is when the heart stops, due to which blood circulation also stops - what we all commonly understand as death. After this type of death, tissues can be donated i.e., eyes (Cornea), skin, heart valves, bones, tendons, cartilage and others. Eye donation can happen even at home. The eyes of the deceased must be closed, and moist cotton placed over the closed lids, the head must be elevated by the use of a pillow, an air conditioner must be switched on if possible & overhead fan must be switched off to prevent drying of the corneas. The family needs to inform the nearest eye bank, give their written consent and the donation must happen within six hours of demise. In Goa, eye donation is yet to take off. In states such as Telangana, Tamil Nadu, and Gujarat, eye donation is an extremely successful programme, which enables the gift of sight to lakhs of corneally blind individuals.
Voluntary body donation is also possible at a Medical College. Family consent is mandatory.
Brain Stem Death / Brain Death
This is caused by severe and irreversible injury to the brain. The brain is made of three parts – the cerebellum, the cerebrum and the brain stem.
The brain stem controls involuntary functions of consciousness, breathing, maintaining blood pressure, digestion etc. If the brain stem stops functioning the patient will not be able to breathe and therefore die. Brain death is permanent and irreversible.
A person whose brain stem is functioning but has lost consciousness due to other parts of the brain getting affected is said to be in a state of coma, which may or may not be reversible. A person in a coma is still alive and breathing by themselves; therefore, the question of organ donation does not arise. Coma is not to be confused with brain death.
THOA mandated a series of tests that 4 doctors from the hospital’s committee, empanelled by the State’s Department of Health Services (DHS) have to perform to confirm and certify brain stem death. One of the doctors has to be a neurologist neurosurgeon intensivist or anesthetist. It is also mandated that these tests are to be repeated after a minimum gap of 6 hours for adults and longer for children, after which the patient can be certified to be brain-dead.
The main causes of brain death are tumours in the brain, brain injury due to Road traffic accidents or falls, and intra-cerebral hemorrhage.
A Brain-dead donor’s vital organs such as heart, lungs, liver, kidneys, pancreas, small intestines and recently even hands can be donated. Furthermore, tissues such as corneas, skin, bones, heart valves etc., can also be donated.
Power of organ donation
One Brain dead person can save up to 8 lives through organ donation and enhance around 50 lives through tissue donation thus passing on the ‘Gift of Life’ to many.
No religion is against organ donation as the act of donating organs is a supreme form of charity and love for fellow human beings.
Deceased organ donation is a sustainable way of putting an end to illegal organ trafficking and organ sales. The best way to become eternal and to be remembered is to recycle our organs by donating them when we don’t need them anymore, rather than burying them or burning them away to ash.
Signing up for organ donation
One can pledge their organs and sign up for a donor card by submitting an online form at www.mohanfoundation.org. In case of any further information or queries, call the Organ Donation Helpline (Toll-Free 24x7) at 1800 103 7100.
(The writer is an Organ Donation Ambassador at MOHAN (Multi Organ Harvesting Aid Network) Foundation, Mapusa)
